Part A: Legislation and political Context: What is the “Elevator Speech” overview?

The Mental Health First Act of 2013 (H.R.274) refers to a proposed legislation that seeks to amend the Public Health Service Act so that the Secretary of Health and Human Services can authorize grants aimed at initiating and sustaining mental health first aid training programs, which are designed to train teachers, police officers and emergency services personnel to deescalate crisis situations, spot symptoms of potential mental disorders, and initiate timely referrals to mental health services (Congress, 2013). The Act requires these mental health first aid training programs to entail: (i) sufficient training regarding mental health resources, as well as where the community health centers are located within the local community and state; (ii) core live training courses regarding the knowledge, resources and skills needed to help people in crisis to link up with suitable local mental healthcare services; and (iii) provide training regarding the protocols and action plans to initiate referrals to mental health centers. In addition, the Act spells out the groups of people to receive training under the program, which includes school administrators and teachers, primary care personnel and nurses, human resources professionals, students, veterans, faith community leaders and audiences (Congress, 2013). Moreover, the Act requires that the training programs help the trainees to be able to deescalate crisis situations safely, spot the potential signs and symptoms of mental disorders, and make timely referrals to mental health care facilities during the early development phases of mental disorders. The Act also requires the secretary, when awarding grants, to make sure there is equal distribution of grants among the various geographical regions in the US, and make sure that the grants are used in accordance with the health training needs of a given population and the target audiences living in rural places (Congress, 2013).

The Mental Health First Act of 2013 was sponsored and introduced by a Republican Senator, Barber Ron on January 15, 2013 and was later referred to the Committee on Energy and Commerce. At present, no Roll Call votes have been made for this bill, which implies that the bill is yet to pass the House, the Senate, and signed by the president to become the law. The bill does not have any co-sponsors with the latest major action relating to the bill involving its referral to the House Committee. A prognosis of the bill done by the National Institute of Mental Health (2013) points out that it has 3 percent chance of passing the committee and 1 percent chance of being passed to become the law. In addition, National Institute of Mental Health (2013) points out the main factor that helped this bill stem from the fact that it was introduced during the 1st year of the Congress; nevertheless, the slim chances of the bill being enacted into law stems from the fact that its sponsor comes from a minority party. Advocates of mental health in Colorado have welcomed the bill as a major step towards improving the currently neglected state of mental healthcare in the United States. For instance, Colorado Behavioral Health Council has stated that the bill will make significant improvements in terms of increasing the efficacy of mental healthcare in the US although the organization is yet to officially testify their support to the Senate. Despite the fact that The Mental Health First Act of 2013 served to address the mental health issues in the larger healthcare system, which is an important move, it is less likely that it will be enacted; this draws on the fact that only 11 percent of the House Bills passed the committee, and only 2 percent were passed to law during 2011-2013 (National Institute of Mental Health, 2013). This implies that, despite the sound objectives of the bill, the sponsors face a substantial challenge in ensuring that the bill is enacted for the good of the American people. Another loophole of the bill is that, despite having sound objectives, it lacks specific details as to how these objectives will be implemented. For instance, the bill mentions grants to be awarded to fund mental health first aid training programs; there are no specific details regarding to the institutions involved and how progress will be measured.

Part B: Problem Analysis: Why is this Bill/Policy important? Should the mayor care? ‎

According to Alana (2012), federal and state policies have not taken into consideration the mounting problem of behavioral health; consequently, mental health providers are not able to get the critical federal and state funds when compared to other safety net providers. At present, community mental health providers are under pressure to meet the existing needs of at risk Americans for the reason that they lack sufficient resources and adequate funding. Mental disorders are a prevalent occurrence in the United States. National Institute of Mental Health (2013) approximates that about 26.2% of Americans aged 18 and above suffer from any given of mental disorder annually, which translates to about 57.7 million Americans. When affirming the burden that mental health disorders impose on the US, National Institute of Mental Health (2013) points out that mental health problems are one of the primary causes of disability in the US.

The current state of mental healthcare in the United States is dismal to an extent that the National Alliance on Mental Illness, during 2009, awarded the country’s mental healthcare system a D-rating commenting that it is failing patients. According to Jansson (2008), mental health services are often among the first victims of budget cuts. It is undeniable that the number of mental healthcare providers is decreasing significantly - something that can be attributed to the government’s disregard for mental healthcare.

The impacts of poor quality and disregarded mental healthcare in the US are prevalent. For instance, the recent massacre that took place at Sandy Hook Elementary School can be traced back to the mental health status of the perpetrators, which resulted in a nationwide debate on the need to improve the state of mental healthcare in the United States. It is undeniable that mental health is becoming an alarmingly big issue and can be correlated to senseless killings and crimes that are being observed in the United States. Kitchener & Jorm (2006) points out that people who have certain forms of mental disorders, if not addressed in a timely manner, can result in them acting in a socially destructive manner and result in heinous acts such as killings and homicides. The situation is worsened by the fact that only 5.6 percent of the national healthcare expenditure is allocated for mental healthcare. Most of this funding is spent on the buying of prescription drugs; the underlying inference is that the government has disregarded mental healthcare. Alana (2012) asserts that the federal policies are focusing on other aspects of healthcare; for instance, a cancer patient is likely to receive a scientifically-backed comprehensive plan having well-trained doctors that are specialized in radiation and chemotherapy; this is not the case for people seeking mental health treatment.

Enacting the Mental Health First Act of 2013 will play an instrumental role addressing the current problems observed in the mental healthcare system in the US. First, enacting the law is a vital in enhancing the quality of mental healthcare in the US. It is imperative to acknowledge that the primary cause of the problem in the US mental healthcare system relates to funding. Inadequate funding implies that some vital aspects of mental healthcare cannot be addressed. Jansson (2008) asserts that there is a positive correlation between funding and the quality of public services; basing on this line of argument, it can be inferred that funding for mental health first aid training programs is the first step towards increasing the quality of mental healthcare in the United States. Consequently, improving the quality of mental healthcare is the first step in eliminating the social destructive impacts associated with prevalent mental disorders.

Just like emergency response programs have been successful in improving the overall quality of healthcare, it is highly likely that mental health first aid would replicate the same level of success in improving the quality of mental healthcare, especially when mental health patients wait to receive suitable professional treatment or when waiting for the crisis to be resolved. In a study undertaken by Kitchener & Jorm (2006), the authors reported that mental health first aid training is an innovative public education program that plays an integral role in helping the public to spot, understand and make necessary steps to respond to potential signs of mental disorders. Programs of the similar nature reported substantial success; a case in point is the Mental Health First Aid course administered by the National Council for Community Behavioral Healthcare, the Missouri Department of Mental Health and the Maryland Department of Health and Mental Hygiene. According to Kitchener & Jorm (2006), the first aid course administered by these authorities have been beneficial to several core professions and audiences such as professionals in primary care, faith communities, educators and school personnel, law enforcement officials, nursing home personnel, volunteers, families and the larger public. In affirming the rationale behind mental health first aid training, a study conducted by Kitchener & Jorm (2006) revealed that individuals who were trained in providing mental first aid showed significant improvements regarding their confidence, helping behavior and knowledge. This provides a ground to rationalize the funding of the first aid training programs as stipulated in the Mental Health First Act of 2013.

Alana (2012) argues that mental health first aid is the most appropriate method for addressing mental health crisis situations and should entail an approach that is preventive, proactive and positive. For instance, consider the case of an unemployed person who is angry at the government and can opt to avert his anger at anything that indicates the presence of the government such as government cars, offices and building. He can opt to set the building or car on fire; however, such cases can be averted if identified early enough. Kitchener & Jorm (2006) maintains that preventive first aid can be applied in several mental illness crises. In this regard, prevention is considered as an integral part of the first aid. Therefore, it is imperative to be wary of any warning signs associated with mental illness; this is a goal proposed under the bill.

Part C: Existing Resources to Deal with Problem

At present, there are a number of national authorities that are directly related to the dissemination of mental health first aid training programs; they include National Council for Community Behavioral Healthcare, the Missouri Department of Mental Health and the Maryland Department of Health and Mental Hygiene. These national authorities will provide a framework on how the training programs can be implemented. For instance, these national authorities are already offering certification courses for mental health first aid; the only limitation they are facing is adequate funding, which has forced the agencies to compel students to pay for the certification, which is a disincentive towards encouraging the public to enroll for such training programs. Since 2008, about 50,000 individuals in the 47 states have enrolled in the mental health first aid trained courses, wherein 1850 were trained to become instructors (National Institute of Mental Health, 2013).

Besides government agencies, there are private organizations that have embarked on providing mental health first aid. For instance, the Journey Health Medical Center provides 12-hour corporate and community mental health aid courses. Most community courses are often to the larger public at a cost of $ 99, which includes the learning materials (Alana, 2012). The corporate courses for the same are also available for businesses, churches, schools and organizations at a cost of $ 99. These organizations have been effective in addressing the issue, given the outcomes of the programs; however, the primary challenge that these programs face is funding. There is insufficient funding from the government directed towards these programs; perhaps, this justifies the reason why the legislation was proposed (Alana, 2012).

The government agencies and private organizations that provide these training courses should embark on increasing the number of trained instructors and procure the adequate learning materials. Sufficient learning materials will guarantee the high quality of training. With government funding, these organizations should offer the training or free or a minimal charge used to pay for the facility that the agency is using. Furthermore, the training should be standardized across all the agencies and private organizations providing the training in order to ensure that certifications are universal. Another recommendation is for these agencies to embark on nationwide campaigns to inform the public of the need and importance of receiving mental health first aid training. It is imperative to sensitize the public in order for them to be responsive towards such programs and for the programs to be effective (Alana, 2012).

Part D: Stakeholders: Getting Down to the Details

There are a number of stakeholders involved in the implementation of the mental health first training programs; they include family and consumer advocacy organizations, institutions of learning, law enforcement officials, the department of public health and environment, department of safety, and various local mental health centers. Specifically, for Colorado, the stakeholders that would be involved for the implementation of this policy would include the Western Interstate Commission for Higher Education, Mental Health America of Colorado, the Colorado Sherriff’s Association, the Colorado Department of Public Health and Environment, the Colorado Department of Corrections, the Colorado Department of Public Safety, the Colorado Division of Behavioral Health, local mental health facilities and the public in general. These stakeholders work together in partnership in order to effectively disseminate the program in communities within the state (Alana, 2012). At present, there are no known interest groups who have come out openly to oppose the proposed bill; this is probably due to the fact that the bill is still in its infancy stage. However, several organizations have openly supported the bill on grounds that it will improve the quality of mental healthcare and the larger healthcare system in the United States. Fundamentally, agencies and private organizations providing mental health first aid training have welcomed the move, especially because it will ease the burden for funding the training programs. For instance, the National Alliance on Mental Illness has openly supported the proposal on grounds that it is a significant stride in addressing the issues facing mental health care in the United States. However, it is highly probable that the bill will be opposed by people arguing that it fails to address the core social problems in America. For instance, the recent massacre that took place at Sandy Hook Elementary School has sparked a debate on whether to address the underlying mental illness issue or tighten the gun control laws in order to avoid a recurrence of such events (Alana, 2012).

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